Kevin Selby, MD; Christine Baumgartner, MD; Theodore R. Levin, MD; Chyke A. Doubeni, MD, MPH; Ann G. Zauber, PhD; Joanne Schottinger, MD; Christopher D. Jensen, PhD; Jeffrey K. Lee, MD; Douglas A. Corley, MD, PhD
Grant Support: The study was done through the National Cancer Institute–funded PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium (U54 CA163262 [Dr. Corley]). Dr. Selby received funding from the Swiss Cancer Research Foundation (BIL KFS-3720-08-2015). Dr. Baumgartner received funding from the Swiss National Science Foundation (P2BEP3_165409).
Disclosures: Dr. Selby reports grants from the Swiss Cancer Research Foundation during the conduct of the study. Dr. Levin reports grants from the National Institutes of Health during the conduct of the study. Dr. Doubeni reports being a member of the U.S. Preventive Services Task Force during the conduct of the study and personal fees from UpToDate outside the submitted work. Dr. Jensen reports grants from the National Cancer Institute during the conduct of the study. Dr. Corley reports grants from the National Cancer Institute during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1361.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: PROSPERO (CRD42016048286). Statistical code: Not applicable. Data set: See the tables, figures, and appendix tables.
Requests for Single Reprints: Kevin Selby, MD, Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612; e-mail, email@example.com.
Current Author Addresses: Drs. Selby, Jensen, and Corley: Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612.
Dr. Baumgartner: Division of Hospital Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94122.
Dr. Levin: Kaiser Permanente Medical Center, 1425 South Main Street, Walnut Creek, CA 94596.
Dr. Doubeni: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Gate 2, Philadelphia, PA 19104.
Dr. Zauber: Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2063A, New York, NY 10017.
Dr. Schottinger: Kaiser Permanente Southern California Permanente Medical Group, 393 East Walnut Street, Pasadena, CA 91188.
Dr. Lee: Division of Gastroenterology, University of California, San Francisco, 1701 Divisadero Street, Suite 120, San Francisco, CA 94115.
Author Contributions: Conception and design: K. Selby, C.A. Doubeni, D.A. Corley.
Analysis and interpretation of the data: K. Selby, C. Baumgartner, T.R. Levin, C.A. Doubeni, A.G. Zauber, J. Schottinger, C.D. Jensen, J.K. Lee, D.A. Corley.
Drafting of the article: K. Selby, C.A. Doubeni, J.K. Lee, D.A. Corley.
Critical revision of the article for important intellectual content: C. Baumgartner, T.R. Levin, C.A. Doubeni, A.G. Zauber, C.D. Jensen, J.K. Lee, D.A. Corley.
Final approval of the article: K. Selby, C. Baumgartner, T.R. Levin, C.A. Doubeni, A.G. Zauber, J. Schottinger, C.D. Jensen, J.K. Lee, D.A. Corley.
Provision of study materials or patients: D.A. Corley.
Statistical expertise: A.G. Zauber, D.A. Corley.
Obtaining of funding: K. Selby, T.R. Levin, C.A. Doubeni, D.A. Corley.
Administrative, technical, or logistic support: C.A. Doubeni, J. Schottinger.
Collection and assembly of data: K. Selby, C. Baumgartner, J.K. Lee, D.A. Corley.
Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide. However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results.
To evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical).
English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017.
Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results.
Two reviewers independently extracted data and ranked study quality; 2 rated overall strength of evidence for each category of study type.
Twenty-three studies were eligible for analysis, including 7 randomized and 16 nonrandomized studies. Three were at low risk of bias. Eleven studies described patient-level interventions (changes to invitation, provision of results or follow-up appointments, and patient navigators), 5 provider-level interventions (reminders or performance data), and 7 system-level interventions (automated referral, precolonoscopy telephone calls, patient registries, and quality improvement efforts). Moderate evidence supported patient navigators and provider reminders or performance data. Evidence for system-level interventions was low. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of −7.4 percentage points (95% CI, −19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points).
More than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis.
Patient navigators and giving providers reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results. Current evidence about useful system-level interventions is scant and insufficient.
National Cancer Institute. (PROSPERO: CRD42016048286)
Selby K, Baumgartner C, Levin TR, Doubeni CA, Zauber AG, Schottinger J, et al. Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests: A Systematic Review. Ann Intern Med. ;167:565–575. doi: 10.7326/M17-1361
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Published: Ann Intern Med. 2017;167(8):565-575.
Published at www.annals.org on 10 October 2017
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